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Table of Contents
REVIEW ARTICLE
Year : 2022  |  Volume : 19  |  Issue : 1  |  Page : 66-74

The efficacy of educational intervention in enhancing person's ability to manage their epilepsy well: A systematic literature review


Department of Psychiatric Nursing, LGBRIMH, Tezpur, Assam, India

Date of Submission13-Sep-2021
Date of Decision02-Dec-2021
Date of Acceptance20-Dec-2021
Date of Web Publication05-Jul-2022

Correspondence Address:
Miss. Rinki Ghosh
Bhattapukur, Agartala - 799 003, Tripura (West)
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iopn.iopn_81_21

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  Abstract 


Epilepsy is one of the most common chronic neurological conditions, with the potential to generate significant morbidity, impaired quality of life, socioeconomic decline, and high health care costs. Self-management is essential for patients who live with a chronic disease. In addition to standard therapeutic options, patients are also urged to engage in epilepsy self-management which is best achieved by delivering educational intervention to enhance their self-management skills. A good self-management enhances self-efficacy and improves overall quality of life. The purpose of the current review was to identify the evidence on the efficacy of educational intervention in enhancing person's ability to manage their epilepsy to improve their quality of life. Various online databases were searched to obtain the literature using appropriate search terms/keywords. Only Randomized controlled studies were included in the review because of their high evidence level and to avoid subject to bias. Databases searched were ScienceDirect, Wiley online library, and Google Scholar. A total of 41 articles with full texts were reviewed, out of which 7 articles met the criteria. The methodological quality of the studies was assessed by using the Jadad scoring system. The outcome measurement of self-management, self-efficacy, drug adherence, quality of life was observed among patients with epilepsy (PWE) and found effective after delivering educational intervention. In the entire studies, the control group received routine care. This systematic review of randomized controlled trial studies emphasized the positive impact of educational interventions for patients diagnosed with epilepsy concerning various outcome measures. Hence, It was concluded that the planned educational intervention empower PWE to engage in good self-management practices and it enhances their self-efficacy, quality of life by improving their sleep quality, decreasing stress, concern, and fears related to epilepsy.

Keywords: Educational intervention, patients with epilepsy, quality of life, self-efficacy, self-management


How to cite this article:
Ghosh R, Baruah A. The efficacy of educational intervention in enhancing person's ability to manage their epilepsy well: A systematic literature review. Indian J Psy Nsg 2022;19:66-74

How to cite this URL:
Ghosh R, Baruah A. The efficacy of educational intervention in enhancing person's ability to manage their epilepsy well: A systematic literature review. Indian J Psy Nsg [serial online] 2022 [cited 2022 Nov 30];19:66-74. Available from: https://www.ijpn.in/text.asp?2022/19/1/66/349896




  Introduction Top


Epilepsy is the second most common and frequently encountered neurological condition that imposes heavy burden on individuals, families, and also on healthcare systems. As per a recent study, 70 million people have epilepsy worldwide and nearly 90% of them are found in developing region.[1] Epilepsy, as per the international league against epilepsy, is defined by at least two unprovoked seizures occurring more than 24 h apart or a single unprovoked seizure with a recurrence risk of at least 60% over the next 10 years or an identifiable epileptic syndrome.[2] The World Health Organization estimated a prevalence of approximately 50 million people with epilepsy throughout the world, out of which 80% belong to low- and middle-income countries.[3] It is estimated that 10–12 million patients with epilepsy (PWE) are living in India, contributing to almost one-sixth of disease load. Epilepsy accounts for over 13 million disability-adjusted life years and is responsible for more than 0.5% of the global burden of disease.[4]

Epilepsy does not affect only physiologically, but it also disturbs the person psychologically, socially. Stress due to uncertain occurrence of the seizure at any point of time and anywhere makes the person to breakdown psychologically. It lowers their self-esteem as a whole and attached stigma perceived by the person affected and others create psychological misbalance. Epilepsy has an impact on all domains of person's life. In addition with pharmacological therapy, psychosocial management of the disease condition is essential to help the person to cope with various psychosocial issues and enhance their overall quality of life. Many factors influence the quality of life of people with epilepsy, including seizure severity, stigma, fear, and the presence of cognitive or psychiatric problems.[5] Patient education is an important component of quality care and is considered to be a therapeutic outcome for PWE.[6] This helps the person follow good self-management practices. Self-management in PWE refers to adaptive health behaviors and activities that an individual can perform to promote seizure control and enhance well-being.[7] Kobau and Dilorio describe behavioral and psychosocial adjustments made by PWT to control seizures and attain a higher quality of life. Behavioral adjustments include medication adherence, adequate sleep, good nutrition, and stress reduction. Coping with the loss of independence and dealing with embarrassment and stigma are psychosocial adjustments. All these adjustments comprise self-management behaviors.[8] PWE have various educational needs and must adopt many self-management behaviors to control their condition.[9] The traditional treatment of epilepsy often emphasizes the medical aspects of epilepsy and control of seizures through medication therapy and pays little attention to the effects of epilepsy on patients' daily life, such as patients' perception of the disorder, coping with the disease and its treatment, and ability to treat complications of epilepsy, although the psychosocial problems of epilepsy may be more disruptive than its physical symptoms for patients.[10]

Various studies suggest the importance of educational intervention to improve self-management skills of persons with epilepsy which enhances their self-efficacy and overall quality of life. Adequate learning on self-management skills helps to control seizure frequency and other related side-effects. The need of the current review is to focus on various randomized controlled studies to find out the evidence on the effectiveness of various educational interventions on persons with epilepsy.

Aim

The aim of the review was to identify the evidence on the efficacy of educational intervention in enhancing person's ability to manage their epilepsy to improve their quality of life and to provide evidence which health professionals can benefit from.

Objective of the review

The objective is to evaluate the efficacy of educational intervention in enhancing person's ability to manage their epilepsy to improve their quality of life.


  Methods Top


Only randomized controlled studies were included in the study due to their high evidence level since studies that are uncontrolled and non-randomized are subject to bias. The studies having the full text were accessed, with appropriate keywords in their titles and abstracts, and the language of which was English were included in the screening. This systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA).

Eligibility criteria

The review was done to identify the studies and articles that describe the effectiveness of various methods of educational intervention/program to help individual manage their epilepsy well.

Inclusion criteria

  1. Full text with abstracts available in English
  2. Study design of quantitative randomized controlled trials (RCTs)
  3. Studies related to various methods of educational intervention/program
  4. One-to-one/group educational program was included
  5. Studies done on the people with epilepsy above 15 years of age
  6. Studies conducted both in India and other countries.


Exclusion criteria

  1. Studies on children diagnosed with epilepsy under the age of 15 years
  2. Studies conducted on family members of epilepsy patients
  3. Study designs other than RCT
  4. Patient of epilepsy with co-morbidities (neurological, medical, and psychiatric illness)
  5. Patient of epilepsy with intellectual or cognitive disabilities.


Literature search strategy and data sources

Various online databases were searched to obtain the literature such as Medline, Pubmed, ScienceDirect, Wiley online library and Google Scholar, and other sources such as Research Gate, other direct websites. A manual search of various sources such as reports, thesis, or dissertation was also made in LGBRIMH library. The search also was limited to studies conducted between 2010 and 2020 (10 years). Reviews were mainly collected with the help of Boolean/phrase search by using the following terms identified from the title, abstract or keywords.

  • Epilepsy
  • Epilepsy self-management
  • Educational intervention and epilepsy
  • Quality of life in epilepsy
  • Epilepsy self-efficacy
  • Self-management and quality of life.


Data extraction and quality assessment

PRISMA flow diagram [Figure 1] was used to select the articles. Eligibility criteria were assessed for extracted data. Included studies were evaluated on the basis of relevance, appropriateness, clarity, and methodology. Those studies that were not meeting the criteria were excluded.
Figure 1: Diagrammatic presentation of the selection process of studies for systematic review

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Data analysis

A preliminary analysis was done by tabulating and translating data. For each included paper author, year of publication, methodology, interventional module, and major findings were columned in the [Table 1].
Table 1: List of Randomized Controlled Trials included in systematic review

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Risk of bias assessment

The methodological quality of RCTs is commonly evaluated in order to assess the risk of biased estimates of treatment effects. In the current review, each individual study was assessed for risk bias using the Jadad scoring system [Table 2]. The Jadad system awards up to 5 points for randomization, blinding and description of dropouts.
Table 2: Methodological quality assessment of the included studies

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  Results Top


Study characteristics

Among all the RCTs selected for the current review, two studies (Seethalakshmi et al.[11] and Dash et al.[15]) conducted in India. The effectiveness of epilepsy education program on self-management was measured in the study done by Seethalakshmi et al.[11] and effect of a structured educational program on drug adherence and self-care management was measured in the study done by Dash et al.[15] Both the studies conducted in the out-patient department of the selected tertiary care center in India. The common inclusion criteria for both the studies were the patients diagnosed with epilepsy with regular follow-up in OPD and be able to understand at least English. Criteria for age was 21-60 years for study done by Seethalakshmi et al.[11] and age criteria for study done by Dash et al.[15] was ≥15 years. Patients with cognitive difficulties were excluded from both the studies. Both studies done by Aliasgharpour et al.[12] and Yadegary et al.[14] were conducted in Iran. The common inclusion criteria for both the studies were the patients diagnosed with epilepsy, receiving antiepilepstic drugs, aged ≥18 years, and at least one episode of seizure during the last year. Aliasgharpour et al.[12] measured the effects of an educational program on self-management in PWE whereas Yadegary et al.[14] conducted the study to determine the effect of a self-management training program on quality of life in PWE. Eshiet et al.[13] conducted the study in Nigeria to evaluate the efficacy of a pharmacist implemented educational treatment program in improving knowledge and perception among people with epilepsy. Hu et al.[16] conducted the study in China to explore the impact of an intensive self-management education strategy on seizure frequency and quality of life in patients with epileptic seizures with prodromes or precipitating factors. Fraser et al.[17] conducted the study in the USA to evaluate the effectiveness of PACES epilepsy self-management program among PWE. In all the studies, participants in the control group received routine care.

Findings of clinical variables

[Table 3] showed the major findings of clinical variables.
Table 3: Findings of clinical variables

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Effectiveness of intervention in various outcome measurements

Self-management

The effectiveness of educational intervention was assessed by Seethalkshmi A et al.,[11] Aliasgharpour et al.[12] and Fraser et al.[17] The study done by Seethalakshni et al.[11] showed significant difference in the self-management among PWE who participated in the epilepsy education program then patients in the control group.

The results of the study done by Aliashgharpour M et al.[12] indicated that self-management behaviors in PWE were improved after attending the educational program then those patients who did not attend the program (control group). However, the study done by Fraser et al.[17] indicated that treatment effect on self-management was significant except in safety management domain but at 6 months' assessment, it was significant only in information management domain but not in other domains of self-management.

Knowledge and perception of epilepsy

Knowledge and perception of epilepsy was measured by Eshiet et al.[13] among people with epilepsy and study findings showed overall increase in knowledge and perception of epilepsy among the study group post intervention than the control group.

Medication adherence

Study done by Dash et al.[15] and Hu et al.[16] found that drug adherence among the study group increased after attending epilepsy education program and mean score showed statistically significant.

Quality of life in epilepsy

Quality of life in epilepsy was assessed by Yadegary et al.,[14] Hu et al.[16] and Fraser et al.[17] Yadegary et al.[14] and Hu et al.[16] found that quality of life was improved among patients in study group after attending education and training session. Study by Fraser et al.[17] found treatment effect at 8 weeks was significant in overall quality of life and in domain of emotional well-being, energy/fatigue and 6 months assessment of post-intervention showed P value not significant in overall QOLIE-31-P but significant only in domain of fatigue and medication effect.

Self-efficacy in epilepsy, generalized anxiety and patient's overall health

Self-efficacy was assessed by Dash et al.[15] and Fraser et al.[17] but there was no significant change in self-efficacy found by Dash et al.[15] among study group after attending educational program but study by Fraser et al.[17] showed self-efficacy improved when assessed after 8 weeks of post intervention but at 6 months' post intervention no significant change in self-efficacy found among study group.

Generalized anxiety and patient's overall health was assessed by Fraser et al.[17] using patient health questionnaire-9 and generalized anxiety disorder-7 but study finding showed no significant change in these domain among the participants in the study group after 6 months' post-assessment.


  Discussion Top


The aim of this review was to find out the evidence on efficacy of educational program on various outcome measures among persons with epilepsy. After various database searching and rigorous screening, total seven randomized controlled studies met the inclusion criteria and the studies were included for the systematic review. All of the studies used various data collection tools for pretest and posttest assessment to evaluate the effectiveness of educational intervention. Some studies prepared structured educational program using various multimedia approaches and some study used educational program developed and standardized by specialists which is used solely for people with epilepsy. Fraser et al.[17] developed their own interventional program called POSES and used in their study. All the studies divided the sample in both study and control group. The control group did not get any educational training during study period except routine care. After the evaluation of the intervention, control group received intervention. Most of the reviewed studies focused on outpatients. Among studies included four studies delivered sessions of educational intervention in a group and three studies used one-to-one teaching method for educational intervention. Effectiveness of educational intervention on outcome variables was observed in all of the studies in subsequent follow-up posttest. However, a study done by Fraser et al.[17] found that treatment was effective more at 8 weeks of post intervention assessment rather than 6 months' follow-up assessment. The study found that the effect of the program was greater immediately on program completion but the challenge remains as to maintaining this level of higher benefit over time.

Limitations

There are several limitations associated with the present review. Meta-analysis couldn't be performed due to significant heterogeneity of outcome measures observed across the studies. Moreover, the articles published in English were only searched and included and search was limited to the articles published in the past 10 years. Further, review is based on a small number of studies.


  Conclusion Top


Patient education is an important component of quality care and is considered to be a therapeutic outcome for PWE. The current review focused on evidence of effectiveness of educational intervention among people with epilepsy. Various randomized studies were scrutinized and evidence of effectiveness of their intervention was found. The studies evaluating educational interventions for persons with epilepsy found encouraging results. Therefore, psycho-educational measures can be delivered to improve self-efficacy, self-management, seizure control, and quality of life in adults with epilepsy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ngugi AK, Bottomley C, Kleinschmidt I, Sander JW, Newton CR. Estimation of the burden of active and life-time epilepsy: A meta-analytic approach. Epilepsia 2010;51:883-90.  Back to cited text no. 1
    
2.
Definition of Epilepsy 2014. International League against Epilepsy. Available form: https://www.ilae.org/guidelines/definition-and-classification/definition-of-epilepsy-2014. [Last accessed on 2021 Aug 02].  Back to cited text no. 2
    
3.
WHO: World Health Organization (WHO) Factsheet: Epilepsy; 2015. Available from: http://www.who.int/mediacentre/factsheets/fs999/en/. [Last accessed on 2021 Aug 02].  Back to cited text no. 3
    
4.
Epilepsy: A Public Health Imperative. World Health Organization; 2019. Available from: https://www.who.int/publications/i/item/epilepsy-a-public-health-imperative. [Last accessed on 2021 Dec 01].  Back to cited text no. 4
    
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Sanyal D, Roy MK. Understanding stigma in epilepsy. Neurosci Today 2004;8:136-9.  Back to cited text no. 5
    
6.
Garnett WR. Antiepileptic drug treatment: Outcomes and adherence. Pharmacotherapy 2000;20:191S-199S.  Back to cited text no. 6
    
7.
Austin JK, Boer H. Disruption in social functioning and services facilitating adjustment for the child and adult with epilepsy. In: Engel J, Pedley T, editors. Epilepsy: A Comprehensive Textbook. Philadelphia: Lippincott-Raven; 1997. p. 2191-201.  Back to cited text no. 7
    
8.
Kobau R, Dilorio C. Epilepsy self management: A comparison of self-efficacy and outcome expectancy for medication adherence and life style behaviors among people with epilepsy. Epilepsy Behav 2003;4:217-25.  Back to cited text no. 8
    
9.
DiIorio C, Escoffery C, McCarty F, Yeager KA, Henry TR, Koganti A, et al. Evaluation of WebEase: An epilepsy self-management Web site. Health Educ Res 2009;24:185-97.  Back to cited text no. 9
    
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Au A, Li P, Chan J, Lui C, Ng P, Kwok A, et al. Predicting the quality of life in Hong Kong Chinese adults with epilepsy. Epilepsy Behav 2002;3:350-7.  Back to cited text no. 10
    
11.
Seethalakshmi A, Shankar V, Samson R. Effectiveness of an epilepsy education programme on the self-management among patients with epilepsy. IOSR J Nurs Health Sci 2015;4:35-41.  Back to cited text no. 11
    
12.
Aliasgharpour M, Dehgahn Nayeri N, Yadegary MA, Haghani H. Effects of an educational program on self-management in patients with epilepsy. Seizure 2012;22:48-52.  Back to cited text no. 12
    
13.
Eshiet U, Okonta J, Ukwe C. The efficacy of a pharmacist implemented educational treatment programme for people with epilepsy: A report of a randomised controlled trial. Seizure 2019;69:147-53.  Back to cited text no. 13
    
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Yadegary MA, Maemodan FG, Nayeri ND, Ghanjekhanlo A. The effect of self-management training on health-related quality of life in patients with epilepsy. Epilepsy Behav 2015;50:108-12.  Back to cited text no. 14
    
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Dash D, Sebastian TM, Aggarwal M, Tripathi M. Impact of health education on drug adherence and self-care in people with epilepsy with low education. Epilepsy Behav 2015;44:213-7.  Back to cited text no. 15
    
16.
Hu M, Zhang C, Xiao X, Guo J, Sun H. Effect of intensive self-management education on seizure frequency and quality of life in epilepsy patients with prodromes or precipitating factors. Seizure 2020;78:38-42.  Back to cited text no. 16
    
17.
Fraser RT, Johnson EK, Lashley S, Barber J, Chaytor N, Miller JW, et al. PACES in epilepsy: Results of a self-management randomized controlled trial. Epilepsia 2015;56:1264-74.  Back to cited text no. 17
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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